Wednesday, October 11, 2006

In an article in Britains The Independent, a clinical psychologist seriously questions the role of drugs and big pharma in solving brain "chemical imbalances" and handling depression. Dr. Rufus May has a different view. Note that when he refers to Arsenal and Tottenham, he is referring to British soccer teams. From the article:

I work as a clinical psychologist in Bradford. Depression, or should I say pain and sadness, are part of life. Yesterday I counselled Celine, an asylum seeker who has been refused asylum despite strong evidence that she is a survivor of political torture. She is demoralised and her spirit is broken. She has no family here and no contact with her family in the Congo. Her problems are not due to a faulty brain, but oppression and isolation. Celine needs both individual support and to find a sense of community and belonging for as long as she is here. After seeing Celine, I felt tremendous shame at what human beings are capable of doing to each other for money and power. But I recovered quickly because I, unlike Celine, have a family and extended network of friends and colleagues who care about me.

I believe it's a myth that there is a worldwide epidemic of clinical depression that needs identifying and treating. The pharmaceutical companies have systematically promoted this myth. In the 10 years up to 2002 the use of antidepressants increased by 234 per cent. Yet still we are told we are more depressed than ever before. The World Health Organisation has a tendency to talk about the widespread and undiagnosed levels of depression internationally, but it also has close links with the pharmaceutical industry.

Yes, it's true that there's a lot of unhappiness in our society, but convincing people it is a medical condition does not help. I meet people who've bought into the idea that their sadness is caused by a chemical imbalance. Many of them have resigned themselves to one cocktail of medication after another. They have given up on their own ability to find a solution. After all, what can they do about their faulty brain-wiring? In fact, the chemical-imbalance theory is extremely dodgy. Joanna Moncrieff, from University College London, is a consultant psychiatrist who has taken a close look at the scientific evidence. She has argued that there is more evidence for psychiatric medication creating a chemical imbalance rather than correcting one. For example, despite it being commonly believed that depression is caused by a serotonin shortage, this relationship is unproven. Research on the serotonin theory is inconclusive, but such is the power of drug company propaganda that most of us accept it as fact.

We also need to question the idea that chemical changes are the main cause of emotional changes. If Arsenal lose to Tottenham I will experience a deep sinking feeling. This will probably be reflected by chemical changes in my brain but they did not cause this; football players did, combined with my attachment to Arsenal. Yet this logic is neatly overlooked by the "blame the brain" explanation for sadness. What we are distracted from is the fact that unhappiness is a social condition. It tells us about our relationships to others, both in the here and now and in the past.

Mother Teresa once observed that in the developing world there is an epidemic of poverty, while in the West there is an epidemic of loneliness. Similarly, the exiled Brazilian drama teacher Augustus Boal was surprised when he discovered that affluent Westerners were considerably unhappier than the deprived and disenfranchised Brazilian peasants he had worked with. His opinion was that the Brazilian peasants were happier because they knew who the enemy was and they had a collective sense of togetherness. In the West people seemed more isolated and unaware of who was oppressing them. He theorised that what had happened to Westerners was that they had internalised the bully - they had developed an inner critic, which he called a "cop in the head".

If you seek psychological help for inner critical thoughts you may well be offered cognitive behavioural therapy (CBT). CBT tries to address the negative thoughts by training people to argue in their mind with their inner critic and substitute it with a rational, calm, optimistic personality. However, I, and many colleagues, have found that deep-seated emotional pain does not often respond to such tinkering. Perhaps, rather than trying to magic away pain with pills or positive thinking strategies, we should accept it, understand it and thereby start to transform it. For example, a friend of mine experiences periods of low mood episodically. Her mother died when she was young. Her problem is grief; fighting it won't make it go away. Some sadness will always be with her but understanding it and learning ways to not fear it will help.

Many psychologists want more resources so they can build an army of cognitive behaviour therapists to battle the beast of depression. In Bradford we are trying a different approach: community development through supporting the growth of self-help groups. I first became aware of the power of self-help groups eight years ago in east London. Dawn was adopted as a child. Now, in her thirties, she was low in mood and had episodes of self-destructiveness. Antidepressants had not helped and my psychological support was limited. Meeting her for limited periods every fortnight, I felt like a poor substitute for a friend. We decided to set up a self-help group called Helping Hands. At the group Dawn met Jean, an older woman who remembered Dawn as a baby. The stories she told Dawn about her early childhood encouraged Dawn to seek out her biological mother. This she did successfully, which led to a significant breakthrough in her sense of who she was.

In Bradford we have about 12 self-help groups, many of which are now jointly staffed by mental health workers and volunteers from the groups. Group members are gaining the confidence to go on to vocational training. We have also set up a network of public meetings that explore different approaches to mental well-being. What we have discovered is that people find a vast range of things helpful in dealing with distress, from diet and herbal medicine, through meditation and spiritual healing, to dance and artistic expression. As a result we have tried to make the mental health service more holistic, introducing t'ai chi and spiritual healing into the local psychiatric hospital.

But we also need to think about prevention. In the 1950s, '60s and '70s it was recognised both here and in the US that the root causes of mental illness were in social conditions. Initiatives focused on narrowing the gap between rich and poor and creating opportunities through education and community groups for self-expression and community regeneration. But with Ronald Reagan and Margaret Thatcher came the denial of society and funding for these projects was pulled. Distress and confusion was due to faulty brains and the market opened up for the drug companies. We now need to reverse this trend. Numbing our minds is not the answer.

Are we more depressed than before? Its difficult to say - there is clearly a lot of loneliness, grief, despair and feelings of inadequacy out there. Modern lifestyles encourage levels of competitiveness that can make us feel very lonely. Advertisers aim to make us dissatisfied with our lives. I would argue that medicalising and numbing our pain does not help; it mystifies its meaning in our lives and ignores the social and psychological avenues to making our lives more fulfilling.